PROJECT SUMMARY Cancer is the leading cause of death among Asian Americans, and mortality from colorectal cancer (CRC) is ranked as the second most common in cancer deaths among Asian Americans. However, recent data show that CRC screening rates are substantially lower for Chinese and Korean Americans (CKAs) compared with other racial/ethnic groups. To date, a small number of community-based studies have reported on the use of single level (participant level only) interventions to increase CRC screening rates among CKAs; however, very little is known about the impact of multi-level (patient-oriented and provider-oriented) interventions on CRC screening adherence among CKA patients in primary care setting. Furthermore, our preliminary data indicate physician's recommendation as the strongest facilitator of CRC screening among CKAs. Thus, the primary objective of the study is to address this important knowledge gap by conducting a randomized controlled trial to determine the impact of a multi-level culturally-sensitive decision support intervention on CRC screening adherence among 400 CKA primary care patients. Previous studies found that facilitating patient decision-making through decision support and providing patient navigation can increase CRC screening among diverse primary care patients. We will culturally adapt existing evidence- based decision support navigation intervention (CA-DSNI) and test its efficacy among 200 CKA men and 200 CKA women aged 50 to 75 eligible for CRC screening. We will recruit the participants from primary care physicians (PCPs) clinics. The study is designed to compare CRC screening outcomes between the CA-DSNI and the Advanced Control (AC). Those randomized to the AC will receive an informational booklet, a stool blood test kit and a reminder by mail. Those randomized to the CA-DSNI will receive everything the AC receives. Additionally, we will provide decision support and navigation contacts to participants, develop an individualized screening plan using a theory-based online Decision Counseling Program, share the plan with the participants' PCPs, and have PCPs to encourage the screening to participants. Using outcomes data collected by survey and medical record review, we will: (1) determine overall CRC screening adherence in the CA-DSNI vs. the AC; (2) measure change in CRC screening decision stage in the CA-DSNI vs. the AC; and (3) Assess CRC screening test-specific (stool blood test vs. colonoscopy) adherence in the CA-DSNI vs. the AC. Additionally, we will evaluate intervention reach, effectiveness, adoption, implementation, and maintenance using interview data. IMPACT: This study represents the first instance in which CA-DSNI will be used with CKAs in primary care practice settings to address a significant cancer disparity. With growing need for linguistically and culturally competent care, more decision support, language facilitation, and navigation efforts may come into care settings. Therefore, having tested interventions ready for the target population will be timely, and medical systems may benefit from having multilevel best practices known and tested for CKAs.